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Images in Neurology |

Dancing Jaw and Dancing Eyes

Roger Kalla, MD1,2; Jurka Meichtry, MD, MSc1,2; Rahel Schumacher, MSc1,2; Dario Cazzoli, PhD2; Roland Wiest, MD3; Eberhard Seifert, MD4; Rene Müri, MD1,2
[+] Author Affiliations
1Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
2Perception and Eye Movement Laboratory, Department of Clinical Research, University of Bern, Bern, Switzerland
3Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
4Department of Otorhinolaryngology, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
JAMA Neurol. 2016;73(1):122. doi:10.1001/jamaneurol.2015.2299.
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This case report describes a man in his 30s who experienced infratentorial bleeding followed by rhythmic horizontal jaw and eye movements and later by pendular nystagmus and soft-palate oscillations.

A man in his early 30s experienced infratentorial bleeding of unknown etiology. Two weeks after this occurrence, he manifested rhythmic horizontal jaw and eye movements (Video). About 5 weeks after the patient’s hemorrhage he was observed to have pendular nystagmus and soft-palate oscillations with a frequency of 3 Hz. Fiberoptic laryngoscopy examination revealed rhythmic movements of the pharynx, root of the tongue, and plicae aryepiclotticae (Video). A diagnosis of oculopalatal tremor was made on the basis of the clinical observations. Findings from the magnetic resonance imaging examination done 8 weeks after the patient’s initial brainstem injury revealed bilateral T2-weighted hyperintense signal changes at the level of the lower olivary nuclei and of the inferior cerebellar peduncles (Figure), corresponding to a disruption of the inhibitory dentato-rubro-olivary pathway (the so-called Guillain-Mollaret triangle).1

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Figure.
Location of the Patient’s Lesion on Magnetic Resonance Imaging (MRI)

A, T2-weighted axial MRI (repetition time, 3780 milliseconds, echo time, 85 milliseconds) at the level of the lower olivary nuclei and of the inferior cerebellar peduncles (arrowheads). B, Coronal fluid-attenuated inversion recovery (FLAIR) sequence indicates bilateral swelling of the olivary nuclei, with left-sided predominance, and bilateral hyperintensities (arrowheads).

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Clinical Presentation of Rhythmic Jaw and Eye Movements

Fiberoptic laryngoscopy examination revealed rhythmic movements of the pharynx, root of the tongue, and plicae aryepiclotticae.

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